Challenges in Cancer Care of Elderly

As a result of vast global improvement of health care and living conditions, the world population is aging. In developed countries, more than half of the cancers occur in patients aged 70 and older. In booming Asian nations, such as India, the aging trend is particularly striking, and therefore geriatric oncology is rapidly coming at the foreground of oncology practice. As these patients have special needs and a different approach to treatment, there is a strong need for the emergence of geriatric oncology as a sub specialty in oncology. Scientific data show that a geriatric assessment identifies many problems in older people with cancer, adds prognostic information, and might improve the outcomes of these patients. There is a genuine unmet requirement to design and implement the following: development of individually tailored geriatric assessment tools for different oncology centers;cooperation of aging and cancer research in the understanding of cancer biology, aging and physiology;improved clinical study designs;development of geriatric oncology programs;and screening tools for geriatric patients made accessible to family physicians.

Cancer, Malnutrition and Cachexia: We Must Break the Triad

Many factors can modify nutritional status in cancer patients, including cachexia, nausea and vomiting, decreased caloric intake or oncologic treatments causing malabsorption. The cachexia-anorexia syndrome is a complex metabolic syndrome associated with cancer and some other palliative conditions characterized by involuntary weight loss involving fat and muscle, anorexia, early satiety, fatigue and weakness due to shifts in metabolism caused by tumour by-products and cytokines. Cachexia is a distressing and debilitating condition, affecting significant numbers of patients with advanced disease and is the primary cause of death in about 20% of all patients with cancer. Though cachexia is most commonly associated with particular tumours, such as head and neck, gastrointestinal tract, pancreas, central nervous system and lung, it may affect any patient with any tumour at any site;no patient and no tumour are excluded. Current treatment for principally depends on its prevention rather than reversing the present disease state, and the clinical results are far from being satisfactory. A careful decision based on good clinical judgement is necessary before deciding to start either enteral or parenteral nutrition, to avoid a useless, costly and difficult treatment. Treatment should be directed toward improvement in the quality of life of the patient and should often include nutritional counseling. It should take into consideration both disease and treatment related factors as well as the cachexia syndrome itself.